**4. Hyperglycemia and CVD relationship**

Compared with individuals without diabetes, patients with T2DM are disproportionately affected by CVD morbidity and mortality. Most of this excess risk is associated with an increased prevalence of risk factors such as hypertension, dyslipidemia, and obesity in these patients. However, hyperglycemia, as a distinct characteristic of DM, appears to be an independent risk factor for all-cause and CVD mortality independent of other modifiable CVD risk factors:


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*Cardiovascular Risk/Disease in Type 2 Diabetes Mellitus DOI: http://dx.doi.org/10.5772/intechopen.97422*

registered in the Swedish National Diabetes Register [47].

lifestyle management aims to, and it is proven to achieve [51]:

• Improvement of fitness, well-being and mental health.

• Improvement of glycemic control,

• Improvement of the lipid profile

• Lowering of blood pressure,

*5.2.1 Medical nutrition therapy*

The specific targets of clinical management are presented in **Table 1**.

Lifestyle interventions addressed to optimize nutrition, increase physical activity, control body weight, stop smoking, are the cornerstone for T2DM therapy, for both glycemic and other CV risk factors [19, 50]. In terms of CV risk control,

• Control of body weight and improvements of obesity-related complications,

Although the Look AHEAD (Action for Health in Diabetes) study did not show. that intensive lifestyle optimization reduces CV events in people with diabetes and obesity, it showed significant control of CV risk factors, with fewer medication requirements and long-term weight loss maintenance (4.7% at eight years) [52].

Medical nutrition therapy is based on healthy eating principles. Its goals are to promote and support healthful eating patterns, with various nutrient-dense foods

**5.1 Specific therapeutic targets**

**5.2 Lifestyle optimization**

The major objectives of clinical management in T2DM are preventing or delaying chronic complications, increasing life expectancy, and quality. The basic principle of clinical management is the "patient-centred" approach, respectively, the intervention's individualisation [19]. The significant reduction of cardiovascular morbidity/mortality implies a multifactorial approach, addressed simultaneously to all CV risk factors. The 7.8-year STENO-2 study, which included patients with T2DM with increased CV risk (microalbuminuria), showed that the multifactorial approach significantly reduced mortality from any cause (20% reduction in absolute risk), 13% in CV mortality and 29% in the absolute risk of CV events [44, 45]. The 21-year assessment showed that life expectancy was extended by eight years in the intensive care group, and the relative risk of HF was reduced by 76% [45]. Analysis of data from an extensive registry has shown that in people with T2DM, simultaneous control of major CV risk factors (blood glucose, blood pressure, cholesterol and lifestyle, no smoking), can reduce over 60% of cardiovascular and coronary atherosclerotic events [46]. Patients with diabetes who have five risk-factor variables within the target ranges (HbA1c, LDL-cholesterol, blood pressure, no albuminuria and no smoking) seem to have lower or no excess risk of overall death or myocardial infarction and/or stroke, as similar to the general population, as shown in a study that included 271,174 patients with T2DM

**5. Therapeutic approach**
